Three weeks after doctor have diagnosed her case, a second patient says: “How did I get endometriosis? No one in my family has it but me.” Joan fervently wants to know why she has been “singled out” by this disease, since her sisters and mother are tree of it.

A third woman explains: “My mother was tortured by menstrual cramps and endometriosis until menopause. Through some miracle, I’m okay. She said I still could get it, too, that the real ‘curse’ is inheriting this kind of pain. Is my mother right?” Diana has been fortunate thus far, but she feels it’s just a matter of time before the first symptom of the disease becomes apparent.

Nearly all his patients with endometriosis routinely ask questions like these; in fact, such questions ate fundamental and make good sense. Could there be a strong hereditary component in a family’s gene pool that determines which of its women will or will not develop endometriosis? Pursuing a genetic link to this disease may provide one kind of clue to its cause, and that pursuit begins with the most basic question: Why me?

In continuing efforts to track down the cause of endometriosis, modern scientists have tended to concentrate on the physiology and chemistry of the disease. They have only just begun to examine the role of heredity more intensively. Specifically, they are looking for evidence of tendencies toward the disease among female relatives on both the maternal and paternal sides of a family. So far, the key to determining whether a woman will develop the disease lies in her inherited predisposition.

Not all genes establish absolutes, such as curly hair, brown eyes, or the shape of fingernails. Some genes set a range of possibility or susceptibility, not an absolute number or condition. You may be genetically predisposed to weight gain, but your actual weight can be environmentally determined by caloric intake, general health, and a combination of personal and regional attitudes about being overweight. A similar type of range applies to predispositions to diseases such as diabetes, cancer, and endometriosis; important genetic dues have recently been found to common mental disorders, too, including Alzheimer’s disease and manic-depressive illness.

Geneticists expect a simple test to be available in the future that will predict above average susceptibility to illnesses, both fatal and disabling, which no doubt could include genetic testing for endometriosis.

Imagine this: by the time such a genetic marker is found, not only could there be a cure for sufferers, but a preventive treatment might be available for those who would contract id For now, a conjunction of heredity and environmental factors for millions of women has resulted in endometriosis—but each woman, still has some control over the management and cure of the disease, despite her family history.

*28\43\4*

How could he say that I should have a complete hysterectomy?

My doctor’s words sounded so insensitive and heartless. After being through so much with him it now sounded like he just wanted to wash his hands of me. His face normally was pleasant but now it reminded me of a Dr Jekyll and Mr Hyde’s face. His good looks and charm had disappeared and were replaced by callousness.

As the tears blurred my vision, my body started trembling. Anger, resentment and despair overpowered my thoughts. I wanted to shout at him, abuse him, scream that it was unfair.

After all that I had been through. The appointments accounted for hours spent waiting, sitting on uncomfortable chairs, reading magazines, looking at the clock and watching its hands move slowly, or staring at the uninspiring paintings on the walls. Then there were the tests, treatments and operations, all of which had been in vain, both mentally and physically.

I kept waiting for my husband to say something. He had always been a great support to me and now when I needed his support the most he was unable to help me.

The doctor was silent. I realised that this would be the last time that I would see him. There would be no more four hour trips travelling to Melbourne to his clinic. No more hours spent huddled with his other patients in the diminutive waiting room.

I was amazed at how quickly his attitude had changed. He had always been so understanding and hopeful. I guess in retrospect I had intrinsically entrusted him to solve my problem.

Seeing him in a different light I noticed how negative his attitude was. I stared at his masked face and words failed me. It appeared that I had been down all the possible avenues and there would never be any children now.

There was not the usual eye contact or friendly goodbye as we parted. Walking past his receptionists desk I remember thinking how I would not be sorry to see die last of her. She had always been so moody and unhelpful. I paused for one moment as the next couple passed by in the corridor on their way to see the doctor. What future lies in store for them? Would they experience the same traumas and ordeals that we had — only to be left with heartbreak at the end?

The lift took longer than usual to reach the ground floor. I walked with my husband out of the building. We still had not spoken a word to each other. When we reached the footpath he put his arm around me and gave me a gentle hug which told me that he too was hurting inside.

Later, after accepting a life without children, we took a good look at our lives and reassessed our priorities; it was a painful process and required courage. We both needed a lot of support and luckily received it from friends and family — and each other.

*98\83\2*

Some gynaecologists believe that a diagnostic laparoscopy for endometriosis is best done just before or during a period when the disease is most active and easier to see. It may be worthwhile discussing this aspect of the timing of your laparoscopy with your gynaecologist.

It is also extremely important that you discuss with your gynaecologist before the operation precisely what she or he intends to do during your laparoscopy if endometriosis is found.

In particular, if endometriosis is found, you need to discuss whether your gynaecologist intends only to diagnose the condition at the time and defer any further surgery until you have considered all the available options or whether it is intended to proceed immediately onto laparoscopic surgery. You should indicate clearly which of the alternatives you want.

Even more importantly, you should discuss what you want your gynaecologist to do if extensive surgery is needed. For example, if organs or large cysts need to be removed do you want a laparotomy performed immediately or do you want it delayed so that you can discuss the operation and consider all your options?

If surgery is performed at the time of your diagnostic laparoscopy it avoids having to undergo the inconvenience and costs of a second period of hospitalisation, a second general anaesthetic and a second recuperation period. But it also means that you will not be able to participate in making any of the decisions regarding your surgery nor will you have the time to make the emotional and psychological adjustments associated with being diagnosed as having a chronic condition such as endometriosis.

*39\83\2*

The main disadvantages are that it cannot treat adhesions, it rarely eradicates endometriomas greater than two centimeters in diameter and, for some women, it has side effects.

The main advantage of surgery is that although it is a more drastic approach to treatment, the effects and side effects are usually relatively short-term when compared to hormonal treatment.

Surgery may also provide immediate relief from symptoms and it allows a pregnancy attempt soon after.

One of the disadvantages of surgery is that it can only remove those implants, cysts and adhesions which the gynecologist can see and recognize and which can be removed without damaging the underlying organs. Following surgery there maybe some endometriosis and/or adhesions remaining because they were overlooked or were too difficult to remove or destroy.

Another disadvantage of surgery is that the surgery itself can cause adhesions, which can themselves cause on-going symptoms. While most surgeons use techniques designed to minimize the development of adhesions, there is no way of predicting who will develop them.

*31/41/5*

For some couples sex is better than ever after the birth of the first child, but often a period of adjustment is necessary. If you both know that things may be a bit different to start with, neither of you is likely to feel rejected by any changes in sexual feelings and behaviour.

Some women lose their libido for a few months after childbirth: sometimes for longer. Many things can put new mothers off sex.

• There may be tender spots around the entrance to the vagina after delivery, especially if a perineal tear or episiotomy has been sutured. It can take a month or more for the genitals to feel comfortable again.

• Hormonal changes after delivery and during breast-feeding make some women slower to become sexually aroused.

• Some women feel that changes in their bodies after pregnancy and childbirth have made them less desirable or have changed their ability to enjoy sex.

• Breasts may be tender and may leak milk during sexual arousal, especially during the early weeks after delivery.

• Many are so tired out by the ph demands of caring for a new baby they have no energy left for sex. All want to do in bed is sleep!

• Adjusting to parenthood can be difficult. Feelings of love and responsibility for the new baby can be so overwhelming that there isn’t much emotional room left for your partner.

• The presence of the baby, especially the same room, may be a block to expressing love and to sexual activity. A father’s libido can also be affected by becoming a parent, or he may be reluctant to initiate sexual activity for fear that his partner isn’t ready for it or that it may hurt her.

When to resume sex

There’s no hard and fast rule. The best time is when you and your partner feel like it, and it’s comfortable and enjoyble for you both. This may be quite soon; birth and will do no harm as long there’s been no problem with delivery that would make it wiser to wait a while (if so, your doctor will have told you). Take it slowly at first, allowing plenty of time become fully aroused.

If any sexual activity hurts, tell partner and suggest how he might stimulate you in more enjoyable ways. Remember that there are many ways (other penis-in-vagina intercourse) that you can both express love and derive sexual faction. If you have any problems at all, tell your partner about them. If you can be open with each other you’ll probably be able to sort things out.

If sex continues to be uncomfortable or painful beyond six weeks after delivery, see your doctor. If lack of libido persists and is causing tension between you and your partner, it often helps if you both talk the problem over with a third person. Yоur doctor, baby health nurse or the Family Planning Association can refer you to a trained counsellor.

*176/31/5*

Suction aspiration and D&E may be done with local or general anaesthetic. In the clinics you are usually given a choice if both are available. In hospitals general anaesthetic is usually used.

Local anaesthetic is very effective for an abortion. Many women are fearful of injections into the cervix, and are surprised when they don’t feel them at all (the cervix is only sensitive to stretching and some movements). During the procedure most feel no pain until the uterus is empty and contracts (as it should, to stop bleeding), causing a cramp like a period pain. This wears off over the next 15-30 seconds, but is usually repeated, at lessening intensity, over the next 5-10 minutes.

The advantages of a local anaesthetic are
that it is cheaper and you don’t have to sleep it off. This means that you can leave the clinic sooner and in your usual state of alertness, particularly important if you have small children to care for when you get home.

Abortion counselling

You will be offered counselling if you go to a clinic or public hospital for abortion. If you arrange the abortion privately, your doctor will counsel you.

Your counsellor will explain how the abortion is done and answer any questions you have about the procedure and its possible complications. You can also discuss future contraception at this stage.

Another important part of counselling is that it allows you to express your feelings about terminating your pregnancy. You aren’t expected to discuss things you’d rather not mention, though many women welcome the opportunity to talk things over with an independent, understanding person. The counsellor will want to make sure that you’re not being persuaded to have an abortion against your wishes, so though partners or family are most welcome during the interview, part of it will be with you alone.

To comply with the law in Australia, your reason for requesting abortion will be written on your record.

*148/31/5*

Inserting an IUD is usually done in a doctor’s rooms or clinic, though if you’re in hospital for some other gynaecological procedure, it may be convenient to insert the device while you’re there. General anaesthetic is rarely warranted. Whether or not local anaesthetic is used is a matter of choice. I prefer to use some local in the cervix: it makes insertion more comfortable for you and easier for me.

Most doctors will explain the insertion procedure to you before going ahead, but I’ll briefly outline the steps.

1 The position of the uterus is checked by pelvic examination at the same time making sure that all the internal reproductive organs feel normal.

2 A speculum is inserted into the vagina to give good access to the cervix, which is swabbed with antiseptic.

3 Local anaesthetic (if used) is injected into the cervix.

4 A tenaculum is attached to the cervix to steady the uterus.

5 A sound is inserted into the uterus to measure the distance from the external os to the fundus. You may feel a contraction like a period cramp when the sound touches the wall of the uterus at the far end of the cavity.

6 The device is loaded into its inserter that is set to the depth measured (some devices need no loading). Then it is inserted into your uterus. You may feel another contraction as the IUD goes into place.

7 The string is trimmed so that about 4 cm protrude from the external os. This length usually curls up behind your cervix. If the string is trimmed too close to the os, it can ‘spike’ or scratch your partner during intercourse.

IUD insertion usually takes 5-10 minutes. Most doctors like you to rest lying down for a further 10 minutes and stay in the waiting room for another 20-30 minutes after you’ve dressed. This is because some women get a reflex faintness a short while after insertion. If you’re going to feel faint, it’s better to be in the doctor’s rooms than in the street or on a bus.

A checkup is usually advised about a month after insertion, and annually while the IUD is in place. Also, your doctor will tell you how to feel for the string after each period to check that the device has not been expelled. Copper and hormone-releasing IUDs need to be replaced from time to time, as recommended by the manufacturer.

What’s the best time for inserting an IUD?

Most importantly, insertion must be at a time when you and your doctor can be quite sure that you’re not pregnant. For this reason, insertion during menstruation used to be advised. Now that we know that the risk of expulsion is higher if insertion is during a period, most doctors advise it during the second week of the cycle. Insertion may be at any time in a cycle in which there’s no chance of pregnancy (which means no intercourse since the last normal period).

*120/31/5*

Libido varies from person to person, and also from time to time during each phase of life. Our overall sex drive can be influenced by health, life situation, attitudes to sex and our past experience.

Temporary reduction in libido can result from physical illness, fatigue, stress and other emotional upsets, hormonal, fluctuations some drugs, negative feelings towards a partner and uncongenial surroundings. On the other hand, our libido can increase when we feel healthy, relaxed, happy, loving and when the ambience is pleasant. Holidays have a very good reputation for stoking up a tin libido.

In the past it was thought that women had less intrinsic sex drive than men. This is no longer believed to be true. Much the perceived difference is now put down to negative attitudes to sex that women have learnt during their upbringing. Some men have also learnt negative attitudes that hamper their libido or can damage their feelings towards women.

Important influences on women’s attitudes to sex include:

• the double standard about se behaviour

• the notion that sex is ‘dirty’, shame and dangerous (risk of pregnancy STD), and that women who enjoy’ openly are ‘bad’

• the widely held belief that women should be sexually submissive to m especially their husbands

• the idea that men ‘are only after sex and don’t care about women’s feelings

• our reticence to speak about intimate emotional or physical matters

• fear or experience of incest, rape sexual harassment

• myths about sex.

The origins of negative attitudes go back a long way. No doubt the Fall in the Garden of Eden and the story of Christ’s virgin birth are important influences. Patriarchal proprietary rights over wives and daughters have made their contribution, as have women’s fears of losing their men to ‘temptresses’.

The Christian doctrine of self-denial viewed all sensual indulgence as weakness (and few would deny that sex is the ultimate pleasure). But what about God’s first command to us in the Bible (Gen. 1:28), that we should ‘be fruitful and multiply’. Whether nature or God created humans, care was taken to ensure that we were provided with powerful mating instincts and sex drives, and that these would be rewarded with intense physical and emotional pleasure. Otherwise we might lose interest, and then what would happen to our species?

With today’s knowledge and new openness about sex, younger women generally have less inhibitions than those of their mothers’ generation and many older women have reviewed their negative attitudes, but there still seem to be a lot of sexual ‘hang-ups’ around.

*90/31/5*

At puberty the increased production of oil I by the sebaceous glands also happens in the scalp, where there are many more closely packed glands than in the skin of the rest of the body. This often makes hair lank and oily within 24 hours of a shampoo. The only solution is to shampoo more often, but don’t overdo it – once a day is enough. Your hair will become less oily towards the end of your teens.

Dandruff

Dandruff is a problem mainly of adolescence and young adults, reaching a peak at about the age of 20, though about 30 per cent of adults over the age of 30 still have the problem. Uncomplicated dandruff won’t otherwise disturb your health, but most of us would prefer to be free of those tiny pale flakes on our shoulders.

We don’t know why dandruff happens. There’s no connection between dandruff and whether the hair is oily or not. An infectious cause has never been proved, so dandruff isn’t contagious. Affected people have more yeasts in the scalp, but reducing the yeasts doesn’t reduce the dandruff. It’s thought that the yeasts are there because of the dandruff rather than vice versa.